Healthcare Provider Details

I. General information

NPI: 1386854479
Provider Name (Legal Business Name): OPTICAL SUPPLIERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-1253 HALAWA VALLEY ST
AIEA HI
96701-3281
US

IV. Provider business mailing address

99-1253 HALAWA VALLEY ST
AIEA HI
96701-3281
US

V. Phone/Fax

Practice location:
  • Phone: 808-486-2933
  • Fax: 808-486-6458
Mailing address:
  • Phone: 808-486-2933
  • Fax: 808-486-6458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberD10-38
License Number StateHI

VIII. Authorized Official

Name: MR. GLENN T. SHIGEMURA
Title or Position: PRESIDENT
Credential:
Phone: 808-486-2933